Six-Year Follow-Up of Immature Tooth Revascularization With Enamel Matrix Proteins

Novel endodontic revascularization techniques have been considered as alternative options for treatment of immature teeth affected by apical periodontitis. The continuous development of the root canal has been recognized as a major advantage of these techniques over traditional apexification approaches. This article reports a case in which endodontic revascularization using extracellular matrix proteins (EMPs) as a scaffold was utilized to treat an immature maxillary lateral incisor with history of trauma and chronic apical periodontitis. The root canal was accessed and sequentially irrigated with sodium hypochlorite (NaOCl) (2 mL, 5.25%), saline solution (10 mL), and gluconate chlorhexidine (10 mL, 0.12%). The root canal was then dried, filled with an antibiotic paste (ciprofloxacin, metronidazole, and minocycline), and sealed for 3 weeks. The antibiotic paste was then removed by irrigating the canal with NaOCl (10 mL, 5.25%). The intracanal scaffold was obtained by injecting a commercially available enamel EMP into the newly formed intracanal blood clot. Mineral trioxide aggregate was used to seal the scaffold in place, and a composite resin restoration was then placed using a universal restorative. At 3 and 72 months, clinical and radiographic analyses demonstrated short- and long-term success of the technique presented. The authors' findings indicate revascularization techniques are promising in the treatment of immature teeth with apical periodontitis. Longitudinal clinical trials are necessary to confirm the findings reported herein.